Opportunities Abound to Improve Mental Health and Psychological Safety in the Workplace
This commentary provides a brief synopsis of the views expressed by the authors of the invited essay "The Business Case," Sari Sairanen, Deanna Matzanke and Doug Smeall. It then discusses the authors' views in light of the Mental Health Commission's framework for a Mental Health Strategy for Canada, titled Toward Recovery and Well-Being, and Dr. Martin Shain's two reports to the Mental Health Commission of Canada – Stress at Work, Mental Injury and the Law in Canada and Tracking the Perfect Legal Storm. The initiatives discussed in the lead paper are then compared with a 2009 consensus statement generated at a forum co-hosted by the Mental Health Commission and the Great-West Life Centre for Mental Health in the Workplace. The consensus statement reflects the recommendation of the forum's 40 participants that a Canadian national standard for psychological health and safety in the workplace should be developed.
It is clear that all three authors of the invited essay "The Business Case" (Sairanen et al. 2011) believe that positive change can be made. Sari Sairanen states, with respect to the Canadian Auto Workers' union (CAW), "We have and continue to focus on developing new and innovative strategies for creating a healthy supportive workplace culture." Scotiabank's representative, Deanna Matzanke, stresses the need for partnerships to obtain the best results from their Global Diversity and Inclusion Strategy. This strategy "makes the commitment to create and maintain an inclusive and accessible workplace for all its employees and recognizes diversity and inclusion as important keys to business sustainability"; Matzanke notes that this commitment is supported by "a long-standing and comprehensive flexible work options policy." Doug Smeall, of Sun Life Financial, reviews the rising tide of disability affecting the Canadian workplace and notes in his concluding remarks that "organizations are finding that if they address organizational culture issues that are impacting on their employees' mental health and if they actively promote health assessment and promotion programs, they positively impact employee morale, productivity and engagement."
All three authors note the need for leadership and commitment to change by placing mental health high on the organizational agenda – a position that reaps positive benefits for employees and employers alike. They also recognize the value of prevention, especially at the primary level before significant issues start to arise. The concept of partnership and involvement of multiple stakeholders is also stressed; much of this also aimed at reducing stigma and discrimination.
Many of the ideas expressed by the three authors closely reflect the work of the Mental Health Commission of Canada (MHCC) In November 2009, following extensive consultations across the country, the MHCC released a framework of seven high-level goals to transform the mental health system (broadly defined), titled Toward Recovery and Well-Being (Mental Health Commission of Canada 2009). The document adopts a "comprehensive" approach that includes transforming the mental health system to one that is accessible and centred on the multiple needs of people and their families. At the same time, it includes mental health promotion and the prevention of mental health problems and illness wherever possible, eliminates stigma and discrimination, and fosters full social inclusion for people living with mental health problems and illnesses. This vision of a transformed system includes not only traditional healthcare but also the other systems in which people live out their daily life, including families, communities, schools and workplaces. Thus, elements of all seven goals for mental health system transformation (Table 1) have relevance for the workplace, and, as described below, the first, second and seventh goals are particularly important.
The first goal stresses that recovery from mental health problems, in the sense of "recovering a meaningful life in the community," is not only possible but much more common than many people think (Jacobson and Greenley 2001). People with mental health problems or illnesses have long argued that what they need is a home, a job, a friend, and evidence shows that opportunities for employment do much to restore mental health. As the following participant in the national consultations indicated, inclusive workplaces have a critical role to play in fostering the hope, expectation and opportunity for recovery:
"I believe very strongly that a community also must include empowering workplaces and work opportunities for recovery. Having meaning, inclusiveness and a sense of autonomy and productivity at 'work,' whether it be part-time [or full-time], is essential to provide structure, hope and recovery." (Public, online participant)
The second goal calls for an "upstream approach" geared to promoting mental health and preventing mental health problems and illnesses from occurring wherever possible. The efforts described by the authors of the three mini-essays in "The Business Case" indicate that steps are already being taken that align with the goal of developing mentally healthy workplaces and promoting employees' mental health at work, a place where most adults spend a large proportion of their waking life. This idea is confirmed by another consultation participant:
"Stressful work environments are responsible for problems of anxiety, depression and other stress-related difficulties in individuals who have previously coped well. Healthy workplace programs will be good prevention methods if companies are given sufficient education to recognize their worth." (Public, online participant)
|Table 1. Goals for mental health system transformation|
|1. People of all ages living with mental health problems and illnesses are actively engaged and supported in their journey of recovery and well-being.|
|2. Mental health is promoted, and mental health problems and illnesses are prevented wherever possible.|
|3. The mental health system responds to the diverse needs of all people in Canada.|
|4. The role of families in promoting well-being and providing care is recognized, and their needs are supported.|
|5. People have equitable and timely access to appropriate and effective programs, treatments, services and supports that are seamlessly integrated around their needs.|
|6. Actions are informed by the best evidence based on multiple sources of knowledge, outcomes are measured and research is advanced.|
|7. People living with mental health problems and illnesses are fully included as valued members of Canadian society.|
|Source: Reproduced with permission from the Mental Health Commission of Canada (2009: 18–19).|
The seventh goal focuses on social inclusion for people living with mental health problems and illnesses and for all people living in Canada. Inclusion in the workplace is a necessary element in achieving this goal, as outlined by Deanna Matzanke in her article. This was also expressed by a participant in the online consultations:
"The workplace is more than a setting; it is an environment where we spend half our life … it is a community … Without equal access to meaningful employment, there can be no talk of equality. Businesses and employers should be put under political pressure to walk the talk. I believe there can be no real improvement in quality of the life of the consumer without having meaningful employment and adequate income." (Public, online participant) (Editor's Note: "Consumer", in this context, refers to the mental health consumer)
Development of the second phase of the Mental Health Strategy, which focuses on how to progress toward achieving the framework goals, is now well under way. To this end, important work has already been undertaken by the Workforce Advisory Committee (WAC) of the MHCC via a number of key initiatives to improve workplace mental health.
Much of the WAC's work is based on two hallmark reports prepared for the MHCC by Dr. Martin Shain. These reports - Stress at Work, Mental Injury and the Law in Canada (Shain 2009) and Tracking the Perfect Legal Storm (Shain 2010) – outline shifts in Canadian jurisprudence and an emerging legal duty of care on the part of employers to provide a psychologically safe work environment which Shain (2010: 1) defines as, "one in which every practical effort is made to avoid reasonably foreseeable injury to the mental health of employees". Shain concludes, and the WAC agrees, that employers need to view mental health and psychological safety through the same lens as physical health and safety.
One of Dr. Shain's recommendations in his 2009 report is this:
"At a social level, the implications of the same legal developments are that national standards need to be developed in connection with both measurement of risks to mental health at work and management of the employment relationship akin to those found in the United Kingdom … While such standards would be in all likelihood non-binding legally, they could have considerable status as means by which employers might demonstrate their commitment to a psychologically safe workplace and show due diligence in both a moral and a legal context." (2009: 9)
As a follow-up to this recommendation and in response to a wide agreement among WAC members about the need for a national standard, a meeting of a diverse group of approximately 40 interested stakeholders was held in Vancouver in 2009. The meeting was co-sponsored by the MHCC and the Great-West Life Centre for Mental Health in the Workplace. The consensus generated at this meeting states, "It is our vision to see the development of a National Standard of Canada for psychological health and safety in the workplace by December 1, 2011, and uptake by employers resulting in a measureable improvement in psychological health and safety within three years of that date."
Based on this output, and Dr. Shain's recommendations, the MHCC has entered into an agreement with the Bureau de Normalisation du Quebec and the Canadian Standards Association to proceed with development of the standard. The projected target date for completion is the first half of 2012.
Most employers want to avoid more red tape and regulatory burden. But many well accepted workplace standards exist without related regulation (e.g. OHSAS 18000, ISO 14000) that assist the users in developing a roadmap they can count on to help them find the right pathway to success. A national standard for psychological health and safety could reduce the cost of research and review of the many different approaches and strategies and provide a credible resource that is independent of any particular service or product provider. It would allow employers to begin to craft solutions unique to their own workplace needs, knowing that extensive thought and consideration had already gone into the standard.
Some employers may be concerned that addressing psychological safety or promoting mental health is something that would be costly and yield no definite return on investment. These concerns often arise from a lack of awareness about the existence of effective approaches for addressing mental health in the workplace. Knowing which approaches might be best or how to tailor them to suit unique needs, and securing resources to implement and sustain them may also be concerns. As a result, employers who are faced with multiple competing demands may decide to do nothing until a crisis erupts – often leading to damage to reputation, job engagement, morale, and the bottom line. The end results may be costs that are much higher than those needed to develop solutions ahead of time. The good news is that providing a psychologically safe work environment is no longer the mystery that it once was. Publicly available tools and resources exist to assist employers and many low cost and no cost approaches can be used to reduce risk.
The WAC's leadership project is one example. On the leadership website (http://www.mhccleadership.ca), videos of eight well-known leaders from labour unions, non-governmental organizations and "big business" stress the importance of the leadership aspect when dealing with workplace mental health. These videos are presented in conjunction with some key ideas to assist organizations to make improvements in managing workplace mental health and psychological safety. The business case for ensuring that workplace mental health and psychological safety are well managed is also outlined on the website. Four key areas are presented: corporate social responsibility, cost-effectiveness, risk management and recruitment and retention.
The MHCC is also taking workplace mental health to heart within its own walls. From the beginning, the organization's leaders have been committed to promoting and protecting the health and well-being of MHCC employees. In early 2010, a Committee of Champions for Optimizing Mental Health in the Workplace, representing a broad cross-section of the organization, was formed to act as a steward of processes and activities related to employee health, well-being and safety. Shortly thereafter, over 70% of MHCC employees, including executives and managers, participated in an assessment process based primarily on qualitative interviews and supplemented with a short online survey regarding workplace stress. While the survey provided a rough assessment of stress levels in the organization, the qualitative data provided rich and specific information about organizational strengths and challenges in promoting and protecting employee well-being and safety in three broad areas: the psychosocial work environment; the design of work; and broader organizational processes such as communication and ongoing learning. Shortly after the release of the assessment findings, the MHCC's Board of Directors approved an overarching policy statement that put into writing the organization's commitment to optimizing the mental and physical health, well-being and safety of its employees. Action planning processes are now under way at various levels of the organization, including the development of an overall monitoring plan.
The importance of the effort employers are making is well-recognized by the public and cannot be understated. This is illustrated by the comments of a participant in the national consultations:
"Just think how many employees support children and seniors – when they lose their jobs it has a massive ripple effect – one that is felt by other social service agencies." (Public, online participant)
The examples provided by Sari Sairanen, Deanna Matzanke and Doug Smeall and the work of the MHCC are both a cause for hope and a call to action to enhance the mental health and productivity of the workforce in today's knowledge-based economy.
About the Author
Ian M.F. Arnold, MD, MSc, DOHS, FRCPC, FCBOM, CRSP, Chairperson, Workforce Advisory Committee, Mental Health Commission of Canada, Consultant, Workplace Health, Safety and Environment
Gillian Mulvale, PhD, MA, BA, Director, Health System Financing and Transformation, Canadian Health Services Research Foundation
Kathy GermAnn, PhD, MSc, BScN, Workplace/Workforce Research and Policy Analyst, Mental Health Commission of Canada
MaryAnn Baynton, MSW, RSW, Consultant, Workplace Mental Health, MaryAnn Baynton and Associates
Jacobson, N. and D. Greenley. 2001. "What Is Recovery? A Conceptual Model and Explication." Psychiatric Services 52(4): 482–85.
Mental Health Commission of Canada. 2009. Toward Recovery and Well-Being: A Framework for a Mental Health Strategy for Canada. Ottawa, ON: Retrieved October 12, 2010. <http://www.mentalhealthcommission.ca/SiteCollectionDocuments/boarddocs/15507_MHCC_EN_final.pdf>.
Sairanen, S., D. Matzanke and D. Smeall. 2011. "The Business Case: Collaborating to Help Employees Maintain Their Mental Well-Being." Healthcare Papers 11(Special Issue): 78–84.
Shain, M. 2009. Stress at Work, Mental Injury and the Law in Canada: A Discussion Paper for the Mental Health Commission of Canada. Calgary, AB: Mental Health Commission of Canada. Retrieved May 6, 2010. <http://www.mentalhealthcommission.ca/SiteCollectionDocuments/Key_Documents/en/2009/Stress%20at%20Work%20MHCC%20V%203%20Feb%202009.pdf>.
Shain, M. 2010. Tracking the Perfect Legal Storm. Prepared for the Mental Health Commission of Canada. Calgary, AB: Mental Health Commission of Canada. Retrieved May 2, 2011. <http://www.mentalhealthcommission.ca/English/Pages/Mentalhealthintheworkplace.aspx>.
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